Presentation Authors: Giulia Lane*, Iryna Crescenze, Priyanka Gupta, Anne Cameron, Ann Arbor, MI
Introduction: There exists a rare clinical subset of patients, often labelled as "chronic cystitis" who develop refractory symptoms and a severely reduced bladder capacity with loss of compliance and even new vesicoureteral reflux (VUR) with reduced renal function, termed here as â€œEnd Stage Bladder.â€ The purpose of this study is to phenotype these patients and describe their disease process.
Methods: This retrospective cohort study evaluated patients with cystitis referred to a tertiary care center for refractory symptoms. Interstitial Cystitis (IC), Bladder Pain Syndrome (BPS), eosinophilic cystitis and non-malignant causes of chronic cystitis who demonstrated more than one of: severely reduced bladder capacity; diffuse mucosal loss; new VUR or loss of compliance were included. Patients with history of pelvic radiation, urologic malignancy, neurogenic bladder or neurologic disease were excluded.
Results: From 2008-2018, 75 patients with chronic cystitis were identified and after exclusions, 30 were included in the study. Most patients were female (n=25, 83%) and Caucasian (n=27, 90%) and had never used tobacco (n=20, 67%). The most frequent comorbidities included asthma (n=19, 63%), anemia (n=17, 57%) and hypertension (n=18, 60%)._x000D_
The median age of onset of bladder symptoms was 63 years (IQR 47,68) and the primary presenting symptom was most often incontinence (n=9, 30%), recurrent urinary tract infections (n=8, 27%) or Urgency/frequency (n=7 23%). The median maximum bladder capacity was 67 mL (IQR 30, 150). At presentation, imaging showed hydronephrosis in 33% (n=10) and VUR in 40% (n=12). Bladder pathology revealed inflammation in most (n=22, 73%), followed by ulcerated (n=15, 50%) or denuded epithelium (n=10, 33%); Eosinophilic cystitis was rare (n=4, 13%). Median follow-up was 18 months (IQR 8,48). At time of the most recent clinical encounter, 25 (83%) patients had undergone urinary diversion. The median time from presentation to urinary diversion was 2 years (IQR 1,8). Age at onset was found to be correlated to proceeding to urinary diversion (p=0.01), however no significant correlation was found between need for urinary diversion and the length of symptom duration or bladder capacity.
Conclusions: In this cohort of patients with End Stage Chronic Cystitis, 83% ultimately required urinary diversion within 2 years of symptom onset. Age at onset was correlated with need for urinary diversion. Larger cohort studies are required to draw conclusions regarding factors predisposing to this severe phenotype.